Provider Demographics
NPI:1760479125
Name:NEW HAVEN CARE CENTER, INC
Entity Type:Organization
Organization Name:NEW HAVEN CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PATAKY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:573-237-2103
Mailing Address - Street 1:9503 HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-1300
Mailing Address - Country:US
Mailing Address - Phone:573-237-2103
Mailing Address - Fax:573-237-3953
Practice Address - Street 1:9503 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-1300
Practice Address - Country:US
Practice Address - Phone:573-237-2103
Practice Address - Fax:573-237-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030642314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101780807Medicaid
MO265415Medicare Oscar/Certification